Non-sputum-based triage and confirmatory diagnostic tests for pediatric TB

Non-sputum-based triage and confirmatory tests are essential for early TB detection and timely treatment in children.

A mini-review was conducted from January 2022 to May 2024, evaluating five studies on non-sputum-based assays for childhood TB diagnosis. Both Microbiological and Clinical Reference Standards were used to assess diagnostic accuracy and triage potential.

Among the confirmatory tests, only the gastric aspiration test with cartridge-based nucleic acid amplification tests (CBNAAT) met the WHO Target Product Profile criteria. However, this method remains invasive and is not suitable for point-of-care testing. Urine testing by gas chromatography-mass spectrometry (GC/MS) or C-ELISA (BJ76/A194) demonstrated high performance but lacked point-of-care applicability in resource-limited settings. Stool testing with CBNAAT is a viable alternative with high specificity but low sensitivity. For triage, urine lipoarabinomannan tests and blood MTB-HR tests show promise based on specificity, practicality, cost, and turnaround time.

This review highlights the performance of non-sputum-based assays for childhood TB and their potential as triage tools. While some other innovations show promise for the triage and/or diagnosis of TB in adults, further studies are needed to evaluate the performance of these tests in pediatric populations.